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Run: Monetary Instrument Sales Log

A BSA-compliant log for cash sales of cashier's checks, money orders, and traveler's checks between $3,000 and $10,000. Use it to capture the required purcha...

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Submission Notice

I understand this record is required by 31 CFR § 1010.415 and must be retained for five years. (required)

Yes No N/A

Transaction Details

Date of Transaction (required)

Time of Transaction (required)

Branch / Location (required)

Total Cash Amount Tendered (USD) (required)

Enter the total cash received. Must be between $3,000.00 and $10,000.00 to require this log.

Type of Monetary Instrument Sold (required)

If 'Other', specify instrument type

Instrument Serial / Check Number (required)

Face Amount of Instrument (USD) (required)

The dollar amount printed on the instrument.

Instrument Made Payable To (Payee Name) (required)

Purchaser Identity

Purchaser Full Legal Name (required)

Purchaser Date of Birth (required)

Required to verify identity per CIP (31 CFR § 1020.220).

Purchaser Street Address (required)

City, State, ZIP (required)

Government-Issued ID Type Presented (required)

ID Number (required)

Record the ID number as it appears on the document.

ID Issuing State or Country (required)

ID Expiration Date (required)

Confirm ID is not expired at time of transaction.

Is the purchaser an existing account holder? (required)

Account Number (last 4 digits only)

Suspicious Activity Screening

Did the purchaser appear to structure the transaction to avoid the $10,000 CTR threshold (e.g., multiple transactions just below $10,000)? (required)

Did the purchaser indicate the instrument is for a third party not present? (required)

If yes, name of third party on whose behalf the purchase is made

Any other unusual behavior or red flags observed? (Optional)

Teller Verification

Teller Full Name (required)

Teller Employee ID (required)

I certify that I personally verified the purchaser's government-issued photo ID, that the information recorded is accurate to the best of my knowledge, and that this log is submitted in compliance with 31 CFR § 1010.415. (required)

Yes No N/A

Flag for Supervisor / BSA Officer Review (required)

Select 'Yes' if any suspicious activity indicator above was answered 'Yes' or if you have any other concern.

Additional Notes for BSA Officer (Optional)

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